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Rogers I, Barron MA. Evaluating the role of Mycobacterium tuberculosis PCR in ruling out active tuberculosis. Am J Infect Control 2024:S0196-6553(24)00582-0. [PMID: 38964661 DOI: 10.1016/j.ajic.2024.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 06/26/2024] [Accepted: 06/27/2024] [Indexed: 07/06/2024]
Abstract
Laboratory algorithms using Acid-Fast Bacilli staining and Mycobacterium tuberculosis (Mtb) polymerase chain reaction (PCR) are often used to remove isolation precautions. A retrospective case review of 52 patients with culture-confirmed pulmonary Mtb revealed 4 subjects with negative sputum Acid-Fast Bacilli smears and negative Mtb PCRs. All had significant risk factors for Mtb and had a positive interferon-gamma release assay. A negative PCR test result does not exclude an Mtb diagnosis.
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Affiliation(s)
- Inge Rogers
- Infection Prevention and Control Department, UCHealth, Medical Center of the Rockies, Loveland, CO.
| | - Michelle A Barron
- Infection Prevention and Control Department, UCHealth, Aurora, CO; Infection Prevention and Control Department, University of Colorado School of Medicine, Aurora, CO.
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Jung YJ, Park JE, Park JW, Lee KS, Chung WY, Park JH, Sheen SS, You S, Sun JS, Park KJ, Kim YJ, Park KJ. Enhancing the interferon-γ release assay through omission of nil and mitogen values. Respir Res 2023; 24:179. [PMID: 37420251 DOI: 10.1186/s12931-023-02485-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 06/26/2023] [Indexed: 07/09/2023] Open
Abstract
PURPOSE To address the limited utility of the interferon (IFN)-γ release assay (IGRA) caused by its variability and inconsistency. METHODS This retrospective cohort study was based on data obtained between 2011 and 2019. QuantiFERON-TB Gold-In-Tube was used to measure IFN-γ levels in nil, tuberculosis (TB) antigen, and mitogen tubes. RESULTS Of 9,378 cases, 431 had active TB. The non-TB group comprised 1,513 IGRA-positive, 7,202 IGRA-negative, and 232 IGRA-indeterminate cases. Nil-tube IFN-γ levels were significantly higher in the active TB group (median = 0.18 IU/mL; interquartile range: 0.09-0.45 IU/mL) than in the IGRA-positive non-TB (0.11 IU/mL; 0.06-0.23 IU/mL) and IGRA-negative non-TB (0.09 IU/mL; 0.05-0.15 IU/mL) groups (P < 0.0001). From receiver operating characteristic analysis, TB antigen tube IFN-γ levels had higher diagnostic utility for active TB than TB antigen minus nil values. In a logistic regression analysis, active TB was the main driver of higher nil values. In the active TB group, after reclassifying the results based on a TB antigen tube IFN-γ level of 0.48 IU/mL, 14/36 cases with negative results and 15/19 cases with indeterminate results became positive, while 1/376 cases with positive results became negative. Overall, the sensitivity for detecting active TB improved from 87.2 to 93.7%. CONCLUSION The results of our comprehensive assessment can aid in IGRA interpretation. Since nil values are governed by TB infection rather than reflecting background noise, TB antigen tube IFN-γ levels should be used without subtracting nil values. Despite indeterminate results, TB antigen tube IFN-γ levels can be informative.
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Affiliation(s)
- Yun Jung Jung
- Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, 164 World cup-ro, Suwon, 16499, Gyeonggi-do, South Korea
| | - Ji Eun Park
- Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, 164 World cup-ro, Suwon, 16499, Gyeonggi-do, South Korea
| | - Ji Won Park
- Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, 164 World cup-ro, Suwon, 16499, Gyeonggi-do, South Korea
| | - Keu Sung Lee
- Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, 164 World cup-ro, Suwon, 16499, Gyeonggi-do, South Korea
| | - Wou Young Chung
- Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, 164 World cup-ro, Suwon, 16499, Gyeonggi-do, South Korea
| | - Joo Hun Park
- Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, 164 World cup-ro, Suwon, 16499, Gyeonggi-do, South Korea
| | - Seung Soo Sheen
- Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, 164 World cup-ro, Suwon, 16499, Gyeonggi-do, South Korea
| | - Seulgi You
- Department of Radiology, Ajou University School of Medicine, Suwon, South Korea
| | - Joo Sung Sun
- Department of Radiology, Ajou University School of Medicine, Suwon, South Korea
| | - Kyung Joo Park
- Department of Radiology, Ajou University School of Medicine, Suwon, South Korea
| | - Youn Jung Kim
- Department of Health and Medical Information, Ajou University Hospital, Suwon, South Korea
| | - Kwang Joo Park
- Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, 164 World cup-ro, Suwon, 16499, Gyeonggi-do, South Korea.
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